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Abstract:

Continuous remote monitoring of patients based on data obtained from an
implantable hemodynamic monitor provides an interactive patient
management system. Using network systems, patients are remotely monitored
to continuously diagnose and treat heart-failure conditions. A screen
displayable summary provides continuous feedback and information to
physicians, patients and authorized third parties. The quick look summary
includes various sites and presentation tailored to match the patients'
and physicians' needs. The quick look summary further includes
intelligent features that understand and retain the user's interests,
preferences and use patterns. Patients, physicians and other caregivers
are seamlessly connected to monitor and serve the chronic needs of
heart-failure patients in a reliable and economic manner.

Claims:

1. A heart failure monitor including a quick look summary implemented in
a network having a web browser and portal interfaces to transfer and
manage data from the heart failure monitor, the web browser and portal
interfaces comprising: a patient portal; a physician portal; and a device
manufacturer portal; said patient, physician and device manufacturer
portals having shared databases and further including secure databases
and encryption systems in data communications thereof.

2. The interface of claim 1 wherein said patient portal includes a quick
look summary tailored to the patient.

3. The interface of claim 2 wherein said quick look summary is
customizable for various patient preferences.

4. The interface of claim 1 wherein said physician portal includes a
quick look summary tailored to the physician.

5. The interface of claim 1 wherein said quick look summary is
customizable for various physician preferences.

6. The interface of claim 1 wherein the data includes at least a one of
the following: an internal cardiac pressure value, an oxygen saturation
value, a pulmonary artery diastolic pressure, a pulmonary artery systolic
pressure, a cardiac-blood temperature value, a right atrial pressure
value.

Description:

[0001] This application is a divisional of U.S. application Ser. No.
10/612,856 filed Jul. 3, 2003, now allowed, which is a divisional of U.S.
application Ser. No. 09/809,915 filed Mar. 16, 2001, now U.S. Pat. No.
6,599,250.

FIELD OF THE INVENTION

[0002] The present invention relates to implantable hemodynamic monitors
(IHMs). Specifically, the invention relates to systems that interface
with various hospital monitoring systems to transfer data from the IHMs
to doctors and other data processing centers. More specifically, the
invention pertains to heart failure data management systems that provide
a concise and reliable summary view of information in a manner that is
useful for clinicians and health care personnel to monitor, assess,
evaluate and treat heart failure conditions in patients. Further, the
invention pertains to a system of a bi-directional communication system
that is network, Internet, intranet and worldwide web compatible to
enable chronic monitoring based on data obtained from the IHMs.

BACKGROUND OF THE INVENTION

[0003] The need to monitor, on a frequent and continuous basis, the vital
signs associated with hospitalized patients particularly those who are
seriously ill is an important aspect of health care. Virtually every
hospitalized patient requires periodic measurement in logging of blood
pressure, temperature, pulse rate, etc. Such monitoring has typically
been performed by having a health care worker periodically visit the
bedside of the patient and measuring and/or observing the patient's vital
signs using dedicated equipment that is either hooked up to the patient
or brought into the patient's room. Such a monitoring procedure is not
ideally cost-effective because of its being highly labor intensive.

[0004] A great many implantable medical devices (IMDs) for cardiac
monitoring and/or therapy whose sensors are located in a blood vessel or
heart chamber and coupled to an implantable monitor or therapy delivery
device are used for diagnosis and therapy. Such systems include, for
example, implantable heart monitors, therapy delivery devices, and drug
delivery devices. All these systems include electrodes for sensing and
sense amplifiers for recording and/or deriving sense event signals from
the intracardiac electrogram (EGM). In current cardiac IMDs that provide
a therapy, sensed event signals are used to control the delivery of the
therapy in accordance with an operating algorithm. Selected EGM signal
segments and sensed event histogram data or the like are stored in an
internal RAM for telemetry to be transmitted to an external programmer at
a later time. Efforts have also been underway for many years to develop
implantable physiologic signal transducers and sensors for temporary or
chronic use in a body organ or vessel usable with such IHMs for
monitoring a physiologic condition other than, or in addition to, the
disease state that is to be controlled by a therapy delivered by the IMD.

[0005] A comprehensive listing of implantable therapy devices are
disclosed in conjunction with implantable sensors for sensing a wide
variety of cardiac physiologic signals in U.S. Pat. No. 5,330,505,
incorporated herein in its entirety by this reference.

[0006] Typically, an IHM measures blood pressure and temperature signal
values which stem from changes in cardiac output that may be caused by
cardiac failure, ventricular tachycardia, flutter or fibrillation. These
variations may reflect a change in the body's need for oxygenated blood.
For example, monitoring of a substantial drop in blood pressure in a
heart chamber, particularly the right ventricle, along or in conjunction
with an accelerated or chaotic EGM, was proposed as an indicator of a
fibrillation or tachycardia sufficient to trigger automatic delivery of
defibrillation or cardioversion shock. More recently, it has been
proposed to monitor the changes in blood pressure by comparing those
values that accompany the normal heart contraction and relaxation to
those that occur during high-rate tachycardia, flutter or fibrillation.

[0007] A number of cardiac pacing systems and algorithms for processing
monitored mean blood pressure or monitored dp/dt have been proposed and
in some instances employed clinically for treating bradycardia. Such
systems and algorithms are designed to sense and respond to mean or dp/dt
changes in blood pressure to change the cardiac pacing rate between an
upper and a lower pacing rate limit in order to control cardiac output.
Examples of IHMs blood pressure and temperature sensors that derive
absolute blood pressure signals and temperature signals are disclosed in
commonly assigned U.S. Pat. Nos. 5,368,040, 5,535,752 and 5,564,434, and
in U.S. Pat. No. 4,791,931, all incorporated by reference herein.

[0008] The Medtronic® Chronicle® Implantable Hemodynamic Monitor
(IHM) disclosed in U.S. Pat. Nos. 6,024,704 and 6,152,885, both
incorporated herein by reference in their totality, employ the leads and
circuitry disclosed in the above-incorporated commonly assigned 5,535,752
and 5,564,434 patents to record absolute blood pressure values for
certain intervals. The recorded data is transmitted to a programmer under
the control of a physician in an uplink telemetry transmission from the
IHM during a telemetry session initiated by downlink telemetry
transmission from the programmer's radio frequency (RF) head and receipt
of an integration command by the IHM. Thus, in accordance to the '704 and
'885 patents, a method is disclosed in which an IHM is used for deriving
reference and absolute pressure signal values using implantable
physiologic sensors to detect relative cardiac pressure signal values for
storage and transmission.

[0009] Further, in accordance with the '704 and '885 patents, calibration
of the reference pressure and/or temperature sensors in relation to an
external calibrated barometric pressure and/or body temperature sensors
could be accomplished. In addition, the same system may be used to
interlace digital signal values related to pulmonary artery diastolic
pressures with the primary cardiac pressure signal values derived from
the right ventricle as disclosed in U.S. Pat. No. 6,155,267, incorporated
herein by reference.

[0010] Heart failure is a progressive disease. While treatment slows the
progression of the disease, current technology does not provide a cure.
The best treatment regimen available to date is a combination of
continuous diagnosis and drug therapy. Once a heart failure patient is in
the hospital, current technology does not provide a continuous means of
monitoring the patient during their stay in the hospital. Current
practice is based on a dedicated programmer that is used to gain access
to the pressure waveforms. Only trained physicians can currently uplink
the data, and this is available only when such a trained physician is
present, and is therefore not available on a continuous basis.

[0011] The present invention enables continuous remote monitoring of
patients. In sharp contrast, prior heart failure management involves
taking measurements of a few variables in the clinic with accurate
catheterization pressures taken only occasionally because of the
difficulty of obtaining them.

[0012] Accordingly, there is a need to provide continuous and reliable
measurements over sustained long period of time. Further, emerging trends
in health care including remote patient management systems require that
the IMD/IHM be compatible with communication systems, including the
Internet, the worldwide web, and similar systems to provide real-time
communications and data exchange between the IHM in a patient and a
remote center where physicians and other experts reside.

SUMMARY OF THE INVENTION

[0013] The present invention relates to chronic data management for
cardiac systems. Specifically, the invention pertains to IHMs that
monitor heart failure. In its broader aspect, the invention relates to
patient management that enables the collection of chronic data for remote
patient management, including remote delivery of clinical diagnosis and
therapy.

[0014] Yet another aspect of the invention includes a user-friendly
screen-displayable data management system that presents clinically
relevant measurements. Another aspect of the invention provides a
software system that enables the translation and transposition of IHM
collected data to be presented to a clinician in a manner to enable
efficient and reliable evaluation of patient conditions remotely.

[0015] The invention further relates to data reduction in a monitoring
system as generally disclosed in co-pending application entitled
"Implantable Medical Devices Monitoring Method and System Regarding Same"
filed on Dec. 15, 1999, U.S. application Ser. No. 09/992,978,
incorporated herein by reference in its entirety.

[0016] The present invention, inter alia, enables the transfer of a
patient's medical data to one or more monitoring stations staffed by
expert personnel to have access to the data in real time. Although the
IHM device implemented in the present invention relates to the
measurement of cardiac pressure, other IHM devices that detect and
transmit additional physiological signals such as oxygen saturation,
pulmonary artery diastolic and systolic pressure, temperature and related
data may be used as the originating device or data source. Transferring
real-time signals from IHMs to various physician portals and locations
provides a highly accentuated medical service and effective chronic
monitoring of patients.

[0017] In one aspect of the present invention an IHM device determines the
hemodynamic status of a patient from measurement of pulmonary pressure
and right atrial pressure obtained from a single absolute pressure sensor
implanted in the right ventricle. Both of these values have been shown to
correlate to the degree and extent of cardiac failure of a patient. The
IHM continually monitors the right ventricular pressure using an absolute
pressure sensor and marks the right ventricular pressure at the moment of
specific events.

[0018] One aspect of the present invention is to provide a means by which
physicians could view data available via real-time telemetry other than
using a local data retrieving system, such as a programmer. Currently,
physicians use the programmer to view the real-time pressure wave along
with the EGM tracing. Using the present invention, the IHM device would
be able to telemeter real time signals to a system via a programmer or
other instrument to a remote location.

[0019] Another aspect of the present invention relates to the presentation
of data from IHMs in a summary view that's useful and familiar to
clinicians and patients. Yet another aspect of the present invention
includes a process by which data is collected by IHMs, which data
includes but is not limited to heart rate patient activity and pressure
data, to establish that the patient is in a state of repeatable data
routine on a daily basis. For example, this might mean application of a
magnet when the patient is lying down, or using devices such as
time-of-day counters, activity sensors, posture sensors, etc. Such data
is retrieved for analysis via home monitors, programmers or similar
devices, and the data sent over an Internet/intranet, worldwide web or a
similar network to a remote location for analysis by clinicians or for
storage and archiving at a Medtronic server.

[0020] The data is processed for collection with past pull-up records to
compose a continuous patient record. Specifically, clinically relevant
measurements are pulled out of the data. This would mean observing the
average values measured during a daily test, including, for example, the
patient reclining for 5 minutes. These values and the deviation or change
are compared against clinical norms and flagged for the user if they are
abnormal. For example, color plus footnote designations may be used to
identify or flag abnormal data. Other variations such as italics,
specialized fonts, bigger fonts, e-mail reports, faxed reports may be
used to identify deviations from normal clinical data or established
chronological data for the patient. The clinical norms can optionally be
modified for each patient by the clinician and then serve as a clinical
baseline for the particular patient.

[0021] One other aspect of the present invention is the display of data
which without limitation, includes the most recent daily test data along
with data from the previously interrogated data. A comparative value
between the two and a previous interrogation date to compare collected
data with chronological data are used.

[0022] Yet another aspect of the present invention includes a single page
view of chronic heart failure status, translation of raw data into
clinical indicators of heart failure status, analysis of changes in
indicators over a user-selectable time period, flags and indicators to
identify changes that are outside of clinical norms, tailoring of
graphical displays and data management to a patient's clinical norms,
means to determine if the patient is in a state of repeatable condition
from day to day, and automated data analysis triaging which provides a
foundation for further data analysis and automation.

BRIEF DESCRIPTION OF THE DRAWINGS

[0023] FIG. 1A shows a diagram illustrating an implantable medical device
that incorporates an absolute cardiac blood pressure sensor and an IHM
device in accordance with the present invention.

[0024] FIG. 1B is a block diagram illustrating various data communication
systems from the IMD.

[0025] FIG. 1C is a block diagram illustrating signal transmission from
the IMD to a remote station.

[0026] FIG. 2 is a block diagram illustrating the remote communication
system within which the present invention is incorporated.

[0027] FIG. 3 is a block diagram representing a web browser and portal
interface for the present invention.

[0028] FIG. 4A is a block diagram representation illustrating a Medtronic
home page at the Medtronic server in which data may be archived in
accordance with the present invention.

[0029]FIG. 4B is a logic flowchart representing high level quick look
summary in accordance with the present invention.

[0032] FIGS. 6& 7 is a quick look summary in accordance with the present
invention.

[0033] FIG. 8 is a representative screen for a trends report.

[0034] FIG. 9 is a representative screen for a trends report similar to
FIG. 8.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

[0035] FIG. 1A represents a patient with implanted medical device
incorporating an absolute cardiac blood pressure sensor such as the IHM
discussed hereinabove. Specifically, IHM/IMD 100 is coupled to an
absolute cardiac blood pressure sensor 120 in a patient's heart 10 for
recording absolute blood pressure values. IMD 100 is depicted implanted
subcutaneously in the patient's chest region and it is coupled at its
connector module 180 to a lead 112 extending through blood vessels into
the right ventricle of the patient's heart 10. The blood pressure sensor
120 is located on lead 112 just proximal to the lead's distal tip 130 for
passively fixing it in position to accommodate continuous movement of the
heart 10. In this structure lead 112 and blood pressure sensor 120
correspond to those disclosed in detail in the above-incorporated
commonly assigned '434 and '752 patents for deriving absolute blood
pressure. The IMD 100 that monitors the physiological condition or state
is programmable and/or can be interrogated by an external instrument such
as a programmer through the use of bi-directional or RF telemetry that
exchanges data and commands via uplink and downlink RF telemetry
transmissions through the patient's skin.

[0036] In the context of an implantable blood pressure monitor a series of
absolute blood pressure signal values are sensed periodically or in
response to a signal provided by hospital personnel for example, a
telemetry downlink signal to initiate real time data transmission. The
absolute blood pressure value signals are continuously transmitted so
that physicians, clinicians, nurses or other medical experts can
determine the status of the patient's cardiac pressures and associated
episodes recorded within the required time of day. The physician uses an
external programmer to generate and transmit an interrogation command via
a downlink telemetry transmission to the IMD 100. IMD 100 recognizes the
command and initiates a continuous uplink telemetry transmission of the
absolute pressure data in response. The uplink telemetry continues until
the IMD system fails to detect further commands.

[0037] FIG. 1B illustrates a general scheme by which patient data could be
transmitted to a remote clinician's station. The communication scheme
enables continuous monitoring of patients either in a hospital setting or
in a home environment. Pressure signals are acquired from the IMD via
telemetry head 22 or equivalent device and uplinked to instrument 24.
Instrument 24 may represent a programmer or an in-home monitor adapted to
communicate with IMD 20. Instrument 24 maintains wireless communication
27 to transfer data to clinician's station 28. Alternatively, instrument
24 may be adapted to transfer data via network 30 representing Internet,
extranet, worldwide web or a similar network. The data is then
transferred to clinician's station via modem, cable or equivalent data
transfer system.

[0038] FIG. 2 represents a detailed aspect of network 30 that is
accessible to patients and physicians within which search engine 40
enables access to various zones 42, including a dedicated public zone 44,
confidential zone 46 and private zone 48. These zones represent various
data management centers that are either interconnected or segregated
based on privacy and security requirements. For example, public zone 44
is accessible to all patients, physicians and the public to provide
general information about medical devices and related medical information
and services. In sharp contract, confidential database 46 and private
information 48 are accessible to patients and physicians based on strict
security and encryption systems for access on a need-to-know basis.

[0040] FIG. 4A is a general representation of a Medtronic home page 70 in
accordance with the present invention. The home page is segregated
between public and private/secure pages. Specifically, a physician
section, patient section and a general public information section are
depicted. The physician's section is highly scalable and operates both on
the public and private secure sections. Similarly, the patient section
relates to information on various medical devices including related
therapy and diagnosis. Further, similar to the physician's site, the
patient site includes private/confidential segments.

[0041]FIG. 4B represents a general logic flow diagram for a quick look
summary in accordance with the present invention. Specifically, the
system is initiated under logic step 80 where long-term data is collected
via IMD 100. The long-term data is refined to determine if the patient is
in a repeatable state under logic step 82. Subsequently, the data is
retrieved and processed under logic step 84. Thereafter, under decision
step 86 the values of the processed data are reviewed to see if they are
abnormal. If these values prove to be abnormal, they are flagged as
abnormal values under logic step 88 and the results are displayed under
logic step 90. In the alternate, if the values are found to be normal,
they are displayed under logic step 90. One of the significant aspects of
the present invention is the presentation of highly user-friendly quick
look summary of data collected by IMD/IHM 100 to clinicians, patients and
other health providers.

[0042] Referring now to FIG. 5A, a representative screen encountered by a
doctor using the Internet site provided in accordance with the present
invention is shown. Specifically, the screen includes various tabs, one
of which is to welcome the user. The welcome screen identifies the doctor
and updates him or her on how many home monitoring records have been
reviewed and how many abnormal events have been detected. The doctor is
also informed of the number of patients who may require review. The
doctor is also given various information regarding his or her practice
and is also informed on what is new in the art vis a vis specific devices
and medical conditions. The screen is highly interactive and based on
past site use behavior of the doctor, the software is able to understand
and retain the doctor's interests and highlight unused features.

[0043] In the "What is New" section, for instance, the screen
interactively provides the doctor with the latest information regarding
clinical studies including the devices that are released in the user's
countries. The "Links" section provides links to related medical sites.
The list of links is maintained by Medtronic, so only approved sites will
appear. The list of potential links is narrowed by the user's areas of
interest. Clinicians can also provide recommended links to their
patients. This will appear in the patient portal and are customized by
the recommended links, the type of devices the patient has implanted, the
local language to be used and a track record of previous links that have
been used.

[0044] Further, patient records of device and recorded data will be
available for viewing and entry. This data may have been collected by
home monitors, programmers, extenders, registration database or imported
from clinic databases. Users can arrange the view of records, listable to
their liking by date, name, ID and status. Specifically, status
indicators are used for home monitoring data yet to be viewed or with
errors. The records may include in-office follow-up test results,
interrogated diagnostic data settings and measurements, data imported
from pacing databases such as EKG indication, medications including
control of compliance, monitoring functions, key physiologic data such as
indications for implant, links to other online components of a patient's
chart such as lab results, notes entered, data integrated across patient
sessions such as episode logs and trends, patient demographics and
patient diary entries.

[0045] The system may also be customized based on whether the portal is
used to store in-home or programmer records for the particular patient.
All parts of the patient's records that are attributable to the patient
are clearly patient private data. Encryption and adequate authentication
must be used for access. Attribution of who enters and edits changes is
also supported by the system software.

[0046] Appointment scheduling provides an automatic means for scheduling
home-monitoring sessions so home monitoring could be conducted without
additional burden on the clinic scheduling staff. Physicians may enter
their prescribed follow-up intervals and then the system can schedule the
follow-up days. Patients can customize their schedule without the help of
the clinical staff. The scheduling may also integrate with the clinic's
in-office scheduling enabling doctor appointments to be made online.

[0047] Accounts billing are automated. Automation of the filling out of
billing statements is also provided. Medical device follow-up regiments
can often automatically be determined from session data. The data is
forwarded to the clinician's billing system or a third party billing
clearing house. Medtronic device registration forms will be web-enabled.
Direct entry on the web or import from un-tethered data entry
applications will be supported. Entry on the web will enable access by
customers rather than field representatives without the high distribution
and support cost encountered today with PC applications.

[0048] Clinical study content will be available to clinical study
investigators. This could include entry of clinical data forms,
discussion groups, newsletter and results reports. The site is customized
based on which studies the user is a part of and the local language used.
Physicians can compare their practice by comparing their practice data to
data aggregated from other practices and practice guidelines. Specific
comparison and points can be offered with custom filters. Eventually data
mining may be offered. This will include and expand on the current
capabilities of the CV views extranet applications. This part of the site
could be customized based on collected user's data that is also made
available for comparisons. Further, information about the user's practice
to derive comparison definitions, for example with other practitioners in
the area of expertise may be provided.

[0049] The site also includes reports for tracking product performance and
will maintain tags on the referring physician. The distribution of
reports is greatly enhanced through web-enabled features. Specifically,
the content is tailored to each practice. For example, product
performance can be incorporated with web devices such as a palm device
which may be on the person of the patient or the physician. Similarly,
the accuracy of reports can be enhanced by joining data. For example,
closer monitoring reports may contain more accurate battery projections
derived from follow-up and continuous monitoring of actual device data.

[0050] The system enables remote viewing. Specifically, users can remotely
view patient stations through instruments connected to the Internet 30.
Sessions with programmers, extenders, acute monitors and home monitors
will be viewed through web browsers or a PC. Users will have access to a
switchboard of available instruments they have rights to connect to and
access the contents thereof. The connection is supported in any order
whether it is browser or instrument first. Preferably, the site is
customized by identifying which instruments the user has access rights
to. Rights are assigned to physicians and clinical personnel as needed.

[0051] In the same manner, the link for patient portal 52 is a secure
website for patients already implanted with Medtronic devices and their
families. It includes the web content that requires secure access not
available in the Medtronic public website 56. Patient portal 52 provides
personalization, automatically providing only the information pertinent
to the patient's device and disease. This is combined with a consistent
user interface for the diverse applications being provided for a highly
distributed user-friendly web experience.

[0052] Welcome screen 155 of FIG. 5A highlights important information with
more detailed features. The site is customized by patient's names, what
devices the patient has implanted, marketing preferences of what news or
new products are of interest, physician control of what the patient has
access to, past portal use to understand interests and highlight unused
features, and what local language the patient uses.

[0053] One of the significant aspects of this site includes a home
monitoring section which closes the loop for home-monitored patients.
These patients can view whether sessions were successful or trouble-shoot
errors. They can gain reassurance by viewing high-level results. Clearly
this will reduce the burden of phone calls on clinicians. The site is
customized by results of home monitoring sessions. The type of implanted
device and home monitor that are proper to a patient are generally
decisions made by the patient's physician. For security reasons
home-monitoring results may be considered patient private data and will
require encryption and user authentication. The site also provides
appointment scheduling in which an automated means for scheduling
home-monitoring sessions is implemented without additional burden on
clinic scheduling staff. Physicians can enter their prescribed follow-up
intervals and the system is intelligent to schedule the follow-up days.
Patients can customize their schedule without the help of the clinical
staff. The scheduling may also integrate with a clinic's in-office
scheduling enabling doctor appointments to be made online.

[0054] Patient portal 52 also includes a diary section where daily medical
journal entries can be captured. Voice or text can be captured either on
the diary screen or potentially on a home monitor. Regardless of where it
is entered, the diary screens would provide options to review and edit
the contents of a diary. By putting the diary online, it is instantly
available to all medical caregivers. Further, the diary does not need
transcription or transfers to become part of a medical chart because of
automatic entry.

[0055] Yet another significant aspect of the screen display at patient
portal 52 includes the management of patient ID cards. Requests for
replacements and validation of patient's information is automated on
patient portal 52. Patients can also print out replacement ID cards for
use while the processing of a permanent card is in progress. Patient
portal 52 also enables patients to control the rights to their records.
Specifically, patients will have rights to grant control and access
rights to their records as they may deem necessary.

[0056] Referring to FIG. 5B, a quick look summary of hemodynamic variables
125 is represented. The screen provides one-week trends for hemodynamic
variables RV pressure waves. For example, triggered episodes could be
selected under a tachy-, brady- or patient-triggered events. A
tachy-triggered event, for example, would inform the user if the patient
has tachy-triggered events. Similarly, a brady-triggered event informs
the user if the patient has brady-triggered events. Further,
patient-triggered events relate to information indicating
patient-triggered events.

[0057] Referring to FIG. 6, quick look summary screen 140 represents
various parameters useful to determine a tachy or brady trigger. A
tachy-trigger notification informs the user if the patient has
tachy-triggered events. If there are tachy-triggered events the device
information network for example, IHM 100, will notify the designated
person, for instance a nurse, doctor or health provider electronically
that events have occurred by e-mail, pager or other means. Similarly, a
brady-triggered notification would be dispatched in the event there are
brady-triggered events. IHM 100 will notify the designated person about
the event. Patient-triggered notification is also dispatched in the same
manner.

[0058] Referring to FIG. 7, under display screen 150, the software system
enables analysis of comparative values based on a comparison of recent
values to values interrogated on a prior time period. Patient portal 52
and physician portal 54 provide various ways of presenting clinical
information. Specifically, daily minimums of heart rate for quick look,
RV systolic pressure, daily minimums of RV diastolic pressure, daily
minimums of estimated pulmonary artery pressure, daily minimums of RV
pulse pressure, daily minimums of RV dp/dt, highlighting out-of-range
heart rate, highlighting out-of-range RV systolic pressure, highlighting
out-of-range RV diastolic pressure, highlighting out-of-range ePAD
pressure, highlighting out-of-range RV pulse pressure, highlighting
out-of-range RV dp/dt, notification of heart rate out-of-range,
notification of RV systolic pressure out-of range, notification of RV
diastolic pressure, notification of ePAD pressure, notification of RV
pulse pressure, notification of RV dp/dt out-of-range, highlighting
changes in heart rate. Specifically, the quick look will determine and
report changes in heart rate which have occurred in a patient between the
daily minimum values contained in the file selected for examination and
the daily minimum values from a previous file. More specifically, values
are compared to determine if the differences lie outside a user-defined
threshold is defined in the quick look setup and can be tailored on a
patient-by-patient basis. This feature allows the user to define
differences either based on actual values or percentages. Highlighting
changes in RV systolic pressure relates to pressures which have occurred
in a patient between the daily minimum values contained in the file
selected for examination and the daily minimum values from a previous
file.

[0059] Highlighting changes in RV diastolic pressure enables the quick
look to determine and report changes in RV diastolic pressure which have
occurred in a patient between the daily minimum values contained in the
file selected for examination and the daily minimum values from a
previous file. Similarly, the quick look will determine and report
changes in RV pulse pressure which have occurred in a patient between the
daily minimum values contained in the file selected for examination and
the daily minimum values from a previous file. Highlighting changes in RV
dp/dt includes determination and reporting of changes in RV dp/dt which
have occurred in the patient between the daily minimum values contained
in the file selected for examination and the daily minimum values from a
previous file. Notification of large heart rate change is implemented by
enabling IHM 100 information network to notify a designated person
electronically that changes in heart rate greater than set targets have
occurred. A notification may be sent by e-mail, pager and an equivalent
medium.

[0060] Similar notification of large RV systolic pressure changes, large
RV diastolic pressure changes, large ePAD pressure changes, large RV
pulse pressure change, and RV dp/dt changes may be made. The quick look
allows the user to select from a list of previous files. A specific file
may be selected for data against which the current file is compared to
determine if hemodynamic values have changed. Accordingly, quick look
compares the daily minimum values from the selected file set of previous
files to show the user variation that may have occurred. Additionally,
while the quick look page allows the user to examine a selected file, its
comparison to threshold values and comparison to a previous file, it also
provides the daily minimum plots to enable the user to see a time/trend
plot of all daily minimum values for all variables. Further, a daily
minimum list may be used to examine a selected file, its comparison to
threshold values and its comparison to a previous file to see a listing
of all daily minimum values for all variables.

[0061] Referring now to FIGS. 8 and 9, trends report 160 and 170 are
represented. Specifically, heart rate, patient activity, systolic and
diastolic pressures and similar cardiac/physiologic parameters collected
over a period of several weeks. Trend reports for night heart rate,
+dp/dt and -dp/dt including pre-ejection systolic time intervals may be
displayed. Trend directions for 12 months to 1 hour may be selected for
review.

[0062] The preceding specific embodiments are illustrative of the practice
of the invention. It is to be understood, therefore, that other
expedients known to those of skill in the art or disclosed herein may be
employed without departing from the invention or the scope of the
appended claim. It is therefore to be understood that the invention may
be practiced otherwise than is specifically described, without departing
from the scope of the present invention. As to every element, it may be
replaced by any one of infinite equivalent alternatives, only some of
which are disclosed in the specification.